Mayo Clinic Laboratories

Mayo Clinic Laboratories Critical Values / Critical Results List

PURPOSE The purpose of this list is to identify the laboratory tests and their respective critical high and critical low values/results. This list pertains to testing that is performed in Rochester, Arizona, Florida, Mayo Clinic Health System (MCHS) and MCL performing sites.

NOTE: Not all the below mentioned tests are done in each facility. A few of the tests have differing values due to instrumentation/methodology differences and are noted with an *.

DEFINITION A Critical Value / Critical Result is defined as A value/result that represents a pathophysiological state at such variance with normal (expected values) as to be life-threatening unless something is done promptly and for which some corrective action could be taken.

NOTE: The critical values/results do not necessarily correspond directly with normal reference ranges, toxic ranges, or therapeutic ranges.

NOTE: In addition to the critical values identified on this list, critical alerts from testing referred to outside laboratories (non-Mayo) will be communicated to clients in accordance with notification standards once those performing laboratories notify Mayo.

HEMATOLOGY Test Report Name Age Critical Low Critical High Units Activated Partial Thromboplastin Time, – ≥ 150 sec Plasma Fibrinogen ≤ 60 – mg/dL Hemoglobin 0 – 7 weeks ≤ 6.0 ≥ 24.0 g/dL Hemoglobin > 7 weeks ≤ 6.0 ≥ 20.0 g/dL INR (International Normalizing Ratio) – ≥ 5.0 Leukocytes – ≥ 100.0 x10(9)/L Absolute Neutrophil Count ≤ 0.5 – x10(9)/L Neutrophils ≤ 0.5 – x10(9)/L Platelets, Blood ≤ 40 ≥ 1000 x10(9)/L CSF White Blood Cell Count ≥ 100.0 Cells/mcL

CHEMISTRY Test Report Name Age Critical Critical High Units Low Ammonia – (Florida units are µmol/L, ≥ 1 yr – ≥ 200 mcmol/L MCHS&RST units are mcmol/L) *Ammonia – Arizona (Deviation in units) ≥ 1 yr – ≥ 500 mcg/dL Ammonia – (Florida units are µmol/L, < 1 yr – ≥ 100 mcmol/L MCHS&RST units are mcmol/L) *Ammonia – Arizona (Deviation in units) < 1 yr – ≥ 150 mcg/dL Bilirubin Total, Serum < 1 yr – ≥ 15.0 mg/dL Calcium, Total ≤ 6.5 ≥ 13.0 mg/dL Calcium, Ionized, Blood < 1 yr ≤ 2.0 ≥ 6.0 mg/dL Calcium, Ionized, Blood ≥ 1 yr ≤ 3.0 ≥ 6.5 mg/dL *Calcium, Ionized, Blood - Florida < 1yr ≤ 3.0 ≥ 5.5 mg/dL (Deviation due to methodology difference) *Calcium, Ionized, Blood - Florida ≥ 1 yr ≤ 3.0 ≥ 6.0 mg/dL (Deviation due to methodology difference) Carbon Monoxide (Carboxyhemoglobin – ≥ 20 % Level) 1 day – Creatinine, Blood/Plasma/Serum – ≥ 1.5 mg/dL 4 weeks 5 weeks – Creatinine, Blood/Plasma/Serum – ≥ 2.0 mg/dL 23 mos Creatinine, Blood/Plasma/Serum 2 yrs – 11 yrs – ≥ 2.5 mg/dL Creatinine, Blood/Plasma/Serum 12 yrs – 15 yrs – ≥ 3.0 mg/dL Creatinine, Blood/Plasma/Serum 16 yrs – 17 yrs – ≥ 10.0 mg/dL Creatine Kinase, Total – ≥ 10,000 U/L FT4 (Free Thyroxine) < 50 yrs – ≥ 7.8 ng/dL FT4 (Free Thyroxine) ≥ 50 yrs – ≥ 6.0 ng/dL FT4 (Free Thyroxine) – Florida All ages - ≥ 7.8 ng/dL Glucose, Plasma/Serum < 4 weeks ≤ 40 ≥ 400 mg/dL Glucose, Plasma/Serum ≥ 4 weeks ≤ 50 ≥ 400 mg/dL Magnesium, Serum ≤ 1.0 ≥ 9.0 mg/dL Osmolality ≤ 190 ≥ 390 mOsm/Kg *pH (MCHS and AZ only) ≤ 7.200 ≥ 7.600 pH *pC02, arterial (MCHS and AZ only) ≤ 20.0 ≥ 70.0 mmHg *pO2 (MCHS) ≤ 40.0 – mmHg *pO2 (AZ) ≤ 45.0 – mmHg Phosphorus ≤ 1.0 – mg/dL Potassium ≤ 2.5 ≥ 6.0 mmol/L Sodium ≤ 120 ≥ 160 mmol/L

TOXICOLOGY/TDM Test Report Name Age Critical Critical High Units Low > 150 Acetaminophen, S – mcg/mL 4 hours after dose Acetone (Volatile Screen), applies to all Any value – mg/dL specimen types detected Amitriptyline and Nortriptyline, S – > 500 ng/mL Butalbital, S – ≥ 10 mcg/mL Caffeine, S – ≥ 30 mcg/mL Carbamazepine, Total, S – ≥ 15.0 mcg/mL Carbamazepine, Free, S – ≥ 4.0 mcg/mL Clomipramine + Norclomipramine, S – > 450 ng/mL Cyanide, B – ≥ 2.0 mcg/mL Desipramine, S – >400 ng/mL Digoxin, S – ≥ 4.0 ng/mL Disopyramide, S – ≥ 7.0 mcg/mL Doxepin and Nordoxepin, S – > 500 ng/mL Ethanol, Blood – ≥ 400 mg/dL Ethanol, Serum – ≥ 400 mg/dL Ethosuximide, S – > 150 mcg/mL Ethylene Glycol, S – ≥ 20 mg/dL Imipramine and Desipramine, S – > 400 ng/mL Isopropanol (Volatile Screen), applies to all Any value – mg/dL specimen types detected Lidocaine, S – > 6.0 mcg/mL Lead, Blood 0 – 15 yrs – ≥ 20 mcg/dL Lead, Blood ≥ 16 yrs – ≥ 70 mcg/dL Lithium, S – > 1.6 mmol/L Methanol (Volatile Screen), applies to all Any value – mg/dL specimen types detected Nortriptyline, S – > 500 ng/mL Phenobarbital, S – ≥ 60.0 mcg/mL Phenytoin, Total, S – ≥ 30.0 mcg/mL Phenytoin, Free, S – ≥ 2.5 mcg/mL Primidone and Phenobarbital, S Primidone – ≥ 15.0 mcg/mL Phenobarbital – ≥ 60.0 mcg/mL Procainamide, S Procainamide – > 12 mcg/mL N-Acetylprocainamide – ≥ 40 mcg/mL Quinidine, S – ≥ 6.0 mcg/mL Salicylates, S – ≥ 50.0 mg/dL Theophylline, S – > 20 mcg/mL Trimipramine, S – > 500 ng/mL Valproic Acid, Free and Total, S Free Valproic Acid – > 30 mcg/mL Total Valproic Acid – ≥ 151 mcg/mL Valproic Acid, Total, S – ≥ 151 mcg/mL

MICROBIOLOGY Result Specimen source and patient details Detection (e.g., stain, culture, nucleic acid, antigen or Blood/plasma/serum, cerebrospinal fluid, metabolomic detection) of a clinically significant bacterium, brain tissue, amniotic fluid, ocular fungus, parasite, or virus (except HIV, hepatitis A through E fluid/corneal scrapings virus, BK virus, cytomegalovirus, Epstein-Barr virus) Identification/detection of a select agent (or other highly pathogenic organism) including, but not limited to Bacillus anthracis, Brucella species, Burkholderia mallei, Burkholderia pseudomallei, Clostridium botulinum, Corynebacterium diphtheriae, Coxiella burnetii, Francisella Any specimen tested tularensis, monkeypox virus, variola virus, Vibrio cholerae, or Yersinia pestis. In the event of an outbreak of a novel contagious microorganism, detection of such an organism may fall into this category. Detection of clinically significant fungi including, but not limited to members of the Mucorales (Zygomycetes) order, dimorphic fungal pathogens (e.g., Histoplasma capsulatum, Any specimen tested Blastomyces dermatitidis, Coccidioides species), Cryptococcus neoformans, Cryptococcus gattii, or Pneumocystis jirovecii Detection of Strongyloides stercoralis larvae Non-intestinal specimen Any specimen tested from a neonate Detection of herpes simplex virus or Bordetella pertussis (< 1 month)